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Monday, September 23, 2013

Why HIV infection in Children is High in Nigeria

By Winifred Ogbebo

A number of countries have gone far in curbing the HIV/AIDS menace. Here in the country, government has intervened in several ways to curtail the spread of the disease and also care for those living with it. One of such ways was supposed to halt mother-to-child transmission of the disease. WINIFRED OGBEBO takes a critical look at the issue and expresses the fear that the country may have to live with the reality for some time.

Nigeria has the highest number of children contracting the Human Immunodeficiency Virus (HIV) in the world, according to the United Nations.

In a document ‘2013 Progress Report On The Global Plan: towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive,’ published by the world body recently, Nigeria was recorded as having had nearly 60,000 Nigerian children infected with the virus in 2012, a figure higher than that of any other country in the world.

The UN said, despite the federal and state governments’ efforts to check the spread of HIV, the prevalence rate of HIV among Nigerian children had remained relatively stagnant with no significant improvement; while that of several other countries was improving with fewer prevalence rates than before.

Expressing worry over the development, the UN body warned that unless Nigeria braced up in curbing HIV in children, the global target in the Millennium Development Goals (MDGs) would not be realised by 2015.

While Nigeria has not recorded significant progress in curbing the prevalence of HIV among children since 2009, several other sub-Saharan African countries, have witnessed a massive reduction in the prevalence rate of the disease.

Botswana, Ethiopia, Ghana, Malawi, Namibia, South Africa, and Zambia all witnessed a 50 per cent decline in new HIV infections in children, while two other countries- the United Republic of Tanzania and Zimbabwe- are very close to achieving this target. This prompted the UN to warn Nigeria to sit up in the fight against HIV in children.

Nigeria accounts for one third of all new HIV infections among children in the 21 priority countries in sub-Saharan Africa, the highest number of any country.

PMTCT is an intervention that is aimed at reducing to less than two per cent the risk of mother to child transmission of HIV through the use of anti-retroviral (ARVs) as either prophylaxis or therapy given to women in pregnancy, labour and during breastfeeding.

In situations where a mother is not receiving ARVs during the breastfeeding period, the breastfed infant is placed on ARV prophylaxis until one week after cessation of all breastfeeding. Where breastfeeding is not possible, the use of infant formula is usually advised as alternative.

The director-general, National Agency for the Control of AIDS (NACA), Prof. John Idoko, has described the PMTCT in Nigeria as one of the greatest challenges of national response on HIV.

He disclosed that the country currently has 1,410 PMTCT sites, still well below the number of sites required for adequate coverage but a significant progress from 650 sites in 2009.

“The number of pregnant women who receive antiretroviral interventions increased from 11 per cent in 2009 to 21 per cent in 2012. This is far from the target we have set for ourselves. As a result, we have been reviewing the reasons behind the slow progress and putting in place new plans and structures to accelerate the progress of PMTCT in the country,” he said.

He has also consistently blamed the slow pace or what he called the lackadaisical attitude of some state governments that are yet to claim ownership and sustain the PMTCT programme in their states and local governments.

Idoko advocated a scale up of PMTCT plan for the whole country but with more investment in the 12 +1 states, including the Federal Capital Territory, which are responsible for 70 per cent of the burden of MTC.

The integration of health services was embarked upon by the federal government, about two years ago to make primary health care centres, a kind of one-stop- shop to the over 70 per cent of Nigerians who live in the rural areas, where they can access HIV, malaria and tuberculosis services.

However, though antenatal visits by pregnant women to these primary health care centres across the zones have improved, a significant number of them still prefer to give birth at home as the 2011 Multiple Indicator Cluster Survey ( MICS) conducted by the National Bureau of Statistics has shown.

The latest report shows that about 50 per cent of pregnant women still deliver at home, a situation, which experts described as alarming.

A midwife at Ekae Primary Health Care Centre, Edo State, who spoke to this reporter on condition of anonymity, expressed her frustration over what she called lack of patronage by pregnant women in the locality.

Blaming it on lack of strategic citing of the health centre, she said most of the pregnant women preferred to patronise the traditional birth attendant, who she said lived only two houses away from the health centre.

The story is almost similar to that of the New Benin Primary Health Care Centre in Benin, the Edo State capital which shares a fence with the cemetery. Even though the well-equipped centre records an influx of people on a daily basis, including pregnant women, no one wants to remain in the place beyond 6 pm for fear of encountering ghosts.

The project manager, FCT Action Committee for AIDS (FACA), Dr. Uche Okoro, corroborated this dangerous trend among pregnant women, even in the FCT. “Yes that’s an issue with us because we recognize the fact that we have a very good turnout of women for ante natal but some of them, for one reason or the order, do not come back to deliver. This worries us because the essence of PMTCT is to ensure that a child that is being delivered is negative and labour is a very crucial issue because a child can become positive if it’s not handled in a proper centre,” he stated.

The executive secretary, FCT Primary Health Care Development Board, Dr. Rilwan Mohammed, explained how it works: “If the woman is already having HIV, then you have to start her on some drugs, ART. Make sure she takes the drugs regularly so that her child will not be infected. During delivery, it is not advised now, but before, we used to carry out elective caesarian session so as to reduce the risk of the baby contracting HIV. But now, the woman is on drugs and the child coming out also is going to be given lluborapin 2.5 milligram per kg body weight. If she continues taking the drugs, and the child continues taking the drugs, the mother can continue breastfeeding that child for 12 good months before she stops.”

Despite increased awareness, pregnant women have continued to patronise traditional birth attendants, majority of whom are ignorant about how to handle the delivery of babies whose mothers are HIV positive. Because they are ignorant, they do not take the necessary precautions and end up putting the newly born babies at risk of contracting the virus.

The MICS has also revealed a huge gap in the PMTCT programme, which is that a lot of women are still ignorant about HIV and many who are infected are not even aware they have it. Nigeria has an estimated 4 million persons living with HIV and majority of them are women.

Idoko said 1.5 million people living with the virus were supposed to be on treatment, but due to paucity of funds, only 500,000 are currently on treatment, leaving a huge gap of one million people.

Last year’s 2012 FACA spread sheet report showed that, 61,298 pregnant women were screened for HIV in FCT, out of which 3,166 tested positive. Out of these HIV positive pregnant women, 3,019 were provided with ART prophylaxis, leaving a gap of 147.

Beside this is the contentious issue of manpower at the primary health care centres where these women are supposed to access care.

Mohammed said “we have trained some staff, but, unfortunately, some of them leave the job- MSS, SURE-P. You find out that they are no longer coming and you realise that you have lost a lot because he or she was fully trained but he is no longer there working in the facility. That’s where we are having problem now. Most of the people that are coming for SURE-P and MSS, it’s either they are not happy with their accommodation issue or problem of payment in their area council.”

He added that “in most of the primary health care centres, the drugs are not available, the staff are not there. So we have so many challenges to contend with, not only with the issue of PMTCT but other issues of medical practice, particularly those related with maternal health. To give service is difficult in the PHCCs. In the FCT, we had 216 before, but now it’s only 202 that have actual staff . Out of them, only 27 are working according to the World Health Organisation (WHO) standard. All of them are just there, no staff, no equipment, no water, no electricity, no waste disposal, nothing. If you look at that also, you will find out that we have 1036 staff in the whole PHCCs in FCT as against 4300 staff needed to at least give minimum services according to the WHO standard.”

According to the executive secretary, only 15 per cent of the PHCCs in FCT have water, boasts of electricity and security and provide optimal services.

“You can see that the PHCCs in FCT and that is an extension of the whole Nigeria is not working. The whole system has failed. The drug revolving system has failed. The nurses are even selling their drugs over there. We are keeping quiet because we have not provided an alternative to them and because the system is not working.

“We have a lot of issues. In some locality where you have some of the primary health care centres, they are not well-staffed. You have only male community health extension workers (CHEW) in some of the centres handling ante natal and some women may not feel comfortable going to deliver where a man is taking delivery. So it’s an issue that can also affect our efforts,” Okoro added.

The primary health care is solely under the local government and it is their duty to make sure that primary health care functions in terms of employment and commodities availability.

“So we are having challenge at that level of making sure that the right health care worker at that level are available at all the time. So it is a big challenge for us, not only in the FCT, even across the country to ensure that the centres are actually equipped in terms of staff and commodities,” he further pointed out. This is an unhealthy development , according to a health expert, Dr. Nelvin Eze.

For many Nigerians who are eagerly awaiting a healthy future generation, it may be a forlorn hope after all.